Eocene foraminiferal biostratigraphy and paleoenvironment of Nagaland, Northeastern India

Abstrac

Assessment of the quality of care in Maternity Waiting Homes (MWHs) in Mulanje District, Malawi

AimMaternal Mortality Ratio (MMR)in Malawi remains high at 439 deaths per 100,000 live births, primarily due to limited access to skilled birth care. Although Malawi established Maternity Waiting Homes (MWHs) to improve access to skilled labour, the quality of care provided in the homes has received limited assessment. The aim of this study was to assess quality of care in the Maternity Waiting Homes in Mulanje, Malawi.MethodsWe conducted a descriptive qualitative study in three MWHs in Mulanje district, Malawi, from December 2015 to January 2016. We conducted a non-participatory observation using a checklist, to assess the physical layout of the facilities, six face-to-face in-depth interviews (IDIs)with health providers and four focus group discussions (FGDs) with 27 pregnant women admitted for more than 48 hours in MWHs. We digitally recorded all FGDs and IDIs simultaneously transcribing and translating them verbatim into English. Data were analysed using thematic analysis.ResultsThere were mixed perceptions towards the quality of care in the MWHs. Factors that were perceived to indicate higher quality included a quiet environment at the MWH and midwifery services. Lack of cooking spaces, lack of 24-hour nursing care, absence of food and recreation services and sleeping on the floor negatively affected perceptions of quality.ConclusionThe study has shown that care provided in MWHs varied across facilities. Perceptions of the quality of care were not uniform and a lack of standards contributed to the differences. Efforts should be made to improve, sustain and standardize care in MWHs in order to improve perceptions of quality of care in MWHs

Participation of Health Facility Governing Committees in Budget and Plan Review and Approval at Lower Health Facility: Experiences from Kigoma Region Tanzania

For the purpose of involving communities in primary healthcare, health facility governing committees (HFGCs) were created. This study focused on meeting frequency, feedback techniques, and difficulties to better understand how HFGCs evaluate and approve plans and budgets. A cross-sectional survey was done with 75 HFGC members from 9 sites. The majority of HFGCs (82.6%) met quarterly to improve the delivery of health services, according to descriptive analysis performed using SPSS 20. Common means of getting comments were notice boards (49.4%), village assembly (94.7%), and unofficial gatherings (69.3%). Misunderstandings (78.7%), power dynamics (61.4%), a lack of financing (81.4%), political interference (60%) and knowledge deficits were among the difficulties. Planning and budgeting were enhanced by effective HFGCs with frequent meetings and feedback systems, which in turn improved healthcare deliver

Revisiting nation branding: An infrastructure financing perspective in Zimbabwe

Purpose: This study aimed to reconfigure nation branding theories and concepts through infrastructure financing intervention. Research methodology: Data were collected using a QUAL to QUAN sequential mixed methods. Results: Qualitative research informed that the infrastructure that is required for nation branding to be road networks; airports; Information Communication Technologies (ICTs); reliable power supply; industrial facilities; tourism facilities; healthcare facilities; educational facilities; educational facilities; and residential accommodation. These were then classified into two, namely, economic and social infrastructure. Results from quantitative research showed that there is a positive relationship between nation branding and infrastructure financing. Also, it showed that road infrastructure and airports were the most related to nation branding with public-private partnerships and bilateral/multilateral loans to finance their development, respectively. Limitations: As a result of the COVID-19, the research did not manage to have some focus groups for a depth understanding and comprehensive response of the participants. Contribution: The results will help the Zimbabwean government consider developing the road networks and airports to enhance the nation’s brand

A framework for public infrastructure financing in Zimbabwe

The Government of Zimbabwe is operating using the mantra: ‘Zimbabwe is open for business’. The notion of opening for business requires robust supporting economic infrastructure for enhanced productivity, in the form of reliable supply of electricity, accessible road/railway transport networks and availability of contemporary Information Communication Technology (ICT) infrastructure. The aim of the study was to develop a framework for making financing decisions for public infrastructure in Zimbabwe. The objectives of the study are to: determine the main sources of public infrastructure financing in Zimbabwe; establish innovative finance’s capacity to close the public infrastructure financing gap in Zimbabwe; assess the role played by public-sector accounting in attracting appropriate and efficient mechanisms to finance public infrastructure in Zimbabwe; and ultimately to develop and recommend a framework for selecting suitable and efficient mechanisms to finance public infrastructure in Zimbabwe. According to literature reviewed, public infrastructure is broadly financed by public sector entities using their own resources (internally financed) or through private sector investments and innovative financing instruments (externally financed). When infrastructure is internally financed, the study is theoretically guided by the Public Goods Theory and the Theory of Public Finance and Public Policy. When externally financed, the Risk Return and Pecking Order theories are important. There are many instruments used to finance public infrastructure and one project may be financed using one or more instruments. Therefore, considerations are given to the need for a framework that helps improve the efficiency of the financing decision. The study was designed as a multiple case study that focused on four sectors of economic infrastructure, that is, transport, energy (electricity), ICT as well as water and sanitation. The research used synchronous mixed methods to achieve the objectives of the study. Qualitative research methods addressed the following objectives: a) to determine the main sources of public infrastructure financing in Zimbabwe; b) to establish innovative finance’s capacity to close the public infrastructure financing gap in Zimbabwe; and c) to assess the role played by public-sector accounting in attracting appropriate and efficient mechanisms to finance public infrastructure in Zimbabwe. Whilst to develop and recommend a framework for selecting suitable and efficient mechanisms to finance public infrastructure in Zimbabwe the study combined qualitative and quantitative research methods. Qualitative data was collected through interviews conducted with officials and staff from government ministries, government departments, as well as parastatal enterprises dealing with the four infrastructure types. The same respondents were asked to complete a survey questionnaire used to address part of the objective that developed a framework for public infrastructure financing. Interview data were triangulated using secondary data extracted from reports and financial statements. Some of the secondary data was collected from the World Bank’s development indicators online repository. Qualitative data analysis was done using RQDA, an open-source computer-aided data analysis software. Findings from the study revealed that the main sources of finance for public infrastructure in Zimbabwe are the government through budget appropriations, and concessionary loans from the China Export-Import Bank. There was also finance obtained from multilateral financial institutions such as the Development Bank of Southern Africa and the African Export-Import Bank. The study revealed that there is currently very limited use of innovative financing instruments such as PPPs in financing public infrastructure in Zimbabwe, despite the country having legislation to support such financing arrangements. The innovations in financing observed in the study entail the use of conventional financing mechanisms in unconventional ways. However, there is scope for improving the financing of public infrastructure using innovative financing mechanisms and significantly mitigate the financing gap. Public sector accountants in Zimbabwe are mainly active in financial reporting, although the financial statements for most ministries, government departments and parastatal enterprises had qualified audit opinions from the Auditor General’s office. Public sector accountants are not active in financial management and cost and management accounting responsibilities. As a result, public sector accountants are not adding value to public money through offering advisory services in the efficient investment of public money, as well as financing public infrastructure assets using the most efficient financing mechanism. There is no uniformly applied framework when making financing decisions for public infrastructure in Zimbabwe. Therefore, a framework was developed and is recommended for use by this study. The developed framework entails eight steps that are interrelated and interconnected. Use of the proposed framework requires availability of data about infrastructure projects that have been done in the past. The study recommends that Zimbabwe should ensure a robust framework for protecting private sector investments, which can be achieved by ensuring policy consistency; creating and implementing a legal framework that protects private capital; and having economically viable infrastructure sectors, that are liberalised to allow private sector participation. The Government of Zimbabwe must take deliberate actions that ensure variety of financing options at the disposal of the public sector to lower costs of financing public infrastructure. It is also important to fully operationalise the legislation and policies designed to facilitate the participation of the private sector in financing public sector projects. Such operationalisation entails a decentralisation of the regulations and policies to the provincial and municipal levels.Thesis (PhD) -- Faculty of Business and Economic Sciences, Accounting, 202

Understanding resilience and coping in child-headed households in Mutasa District, Zimbabwe

Zimbabwe had 50 000 child-headed households (CHH) in 2002 and by 2010, the figure had gone up to more than 100 000, making Zimbabwe the African country with the highest number of CHH (UNICEF & UNAIDS 2010). These statistics gave rise to the sprouting of many organisations and programmes aimed at catering for the needs of the affected children. Not much attention is given to what the CHH can do for themselves and how they have be surviving without outside help. The present study explored the resilience factors and coping strategies used by children living in CHH in the Mutasa District, Zimbabwe. The mixed method concurrent triangulation design was used in the study and a constructionist theoretical framework was adopted. Semi-structured interviews and focus group discussions were used to collect data from 28 children in CHH, 46 community members, 24 teachers, 25 child service professionals, 10 advisory panel members, 3 government officials involved in policy formulation and implementation and 5 members of the CHH’s extended family. The Resilience Scale was administered to the CHH and the Tree of Life and problem solving activities were carried out with the children. Resilience scores obtained from the children in CHH were in the high to very high category of resilience. The qualitative data was thematically analysed. The research findings indicate that children in CHH use problem focused coping strategies. Their resilience is anchored in both individual and environmental factors. A Bidirectional Model of Resilience that is based on the findings emerged from the study.Three pathways to resilience that are embedded in this model were identified, furthermore the Self-Efficacy Strengths-Focused Model of Coping was proposed. Intervention strategies to foster resilience in CHH should focus on creating coping enabling environments and strengthening individual characteristics.PsychologyPh.D. (Psychology

A framework for public infrastructure financing in Zimbabwe

The Government of Zimbabwe is operating using the mantra: ‘Zimbabwe is open for business’. The notion of opening for business requires robust supporting economic infrastructure for enhanced productivity, in the form of reliable supply of electricity, accessible road/railway transport networks and availability of contemporary Information Communication Technology (ICT) infrastructure. The aim of the study was to develop a framework for making financing decisions for public infrastructure in Zimbabwe. The objectives of the study are to: determine the main sources of public infrastructure financing in Zimbabwe; establish innovative finance’s capacity to close the public infrastructure financing gap in Zimbabwe; assess the role played by public-sector accounting in attracting appropriate and efficient mechanisms to finance public infrastructure in Zimbabwe; and ultimately to develop and recommend a framework for selecting suitable and efficient mechanisms to finance public infrastructure in Zimbabwe. According to literature reviewed, public infrastructure is broadly financed by public sector entities using their own resources (internally financed) or through private sector investments and innovative financing instruments (externally financed). When infrastructure is internally financed, the study is theoretically guided by the Public Goods Theory and the Theory of Public Finance and Public Policy. When externally financed, the Risk Return and Pecking Order theories are important. There are many instruments used to finance public infrastructure and one project may be financed using one or more instruments. Therefore, considerations are given to the need for a framework that helps improve the efficiency of the financing decision. The study was designed as a multiple case study that focused on four sectors of economic infrastructure, that is, transport, energy (electricity), ICT as well as water and sanitation. The research used synchronous mixed methods to achieve the objectives of the study. Qualitative research methods addressed the following objectives: a) to determine the main sources of public infrastructure financing in Zimbabwe; b) to establish innovative finance’s capacity to close the public infrastructure financing gap in Zimbabwe; and c) to assess the role played by public-sector accounting in attracting appropriate and efficient mechanisms to finance public infrastructure in Zimbabwe. Whilst to develop and recommend a framework for selecting suitable and efficient mechanisms to finance public infrastructure in Zimbabwe the study combined qualitative and quantitative research methods. Qualitative data was collected through interviews conducted with officials and staff from government ministries, government departments, as well as parastatal enterprises dealing with the four infrastructure types. The same respondents were asked to complete a survey questionnaire used to address part of the objective that developed a framework for public infrastructure financing. Interview data were triangulated using secondary data extracted from reports and financial statements. Some of the secondary data was collected from the World Bank’s development indicators online repository. Qualitative data analysis was done using RQDA, an open-source computer-aided data analysis software. Findings from the study revealed that the main sources of finance for public infrastructure in Zimbabwe are the government through budget appropriations, and concessionary loans from the China Export-Import Bank. There was also finance obtained from multilateral financial institutions such as the Development Bank of Southern Africa and the African Export-Import Bank. The study revealed that there is currently very limited use of innovative financing instruments such as PPPs in financing public infrastructure in Zimbabwe, despite the country having legislation to support such financing arrangements. The innovations in financing observed in the study entail the use of conventional financing mechanisms in unconventional ways. However, there is scope for improving the financing of public infrastructure using innovative financing mechanisms and significantly mitigate the financing gap. Public sector accountants in Zimbabwe are mainly active in financial reporting, although the financial statements for most ministries, government departments and parastatal enterprises had qualified audit opinions from the Auditor General’s office. Public sector accountants are not active in financial management and cost and management accounting responsibilities. As a result, public sector accountants are not adding value to public money through offering advisory services in the efficient investment of public money, as well as financing public infrastructure assets using the most efficient financing mechanism. There is no uniformly applied framework when making financing decisions for public infrastructure in Zimbabwe. Therefore, a framework was developed and is recommended for use by this study. The developed framework entails eight steps that are interrelated and interconnected. Use of the proposed framework requires availability of data about infrastructure projects that have been done in the past. The study recommends that Zimbabwe should ensure a robust framework for protecting private sector investments, which can be achieved by ensuring policy consistency; creating and implementing a legal framework that protects private capital; and having economically viable infrastructure sectors, that are liberalised to allow private sector participation. The Government of Zimbabwe must take deliberate actions that ensure variety of financing options at the disposal of the public sector to lower costs of financing public infrastructure. It is also important to fully operationalise the legislation and policies designed to facilitate the participation of the private sector in financing public sector projects. Such operationalisation entails a decentralisation of the regulations and policies to the provincial and municipal levels.Thesis (PhD) -- Faculty of Business and Economic Sciences, Accounting, 202

Low Sputum Smear Positive Tuberculosis among Pulmonary Tuberculosis Suspects in a Tertiary Hospital in Mwanza, Tanzania

Early diagnosis of tuberculosis (TB) and prompt initiation of treatment are essential for an effective tuberculosis control programme. In many resource limited settings microscopic diagnosis is still the pivotal tool in the diagnosis of pulmonary TB. This study aimed at evaluating laboratory microscopic diagnosis of tuberculosis in a tertiary hospital in Mwanza, Tanzania. This retrospective hospital based study reviewed consecutively from TB registry and patients’ files a total of 5,922 TB suspects who submitted their sputum for examination between January 2007 and May 2010 at Bugando Medical Centre (BMC). Among TB suspects (mean age=36.1±13.6 years) female accounted for 54.1% of the patients. The prevalence of HIV among TB patients was 59.4%. The sputum smear positivity rate among the TB suspects was 6.1%; the rate was higher in HIV positive than in HIV negative patients (9.9 % versus 3.2%, P-value < 0.001). The overall positivity rate for the first smear was 94.2% with an incremental percentage yield of 5.2% and 0.6% for the second and third smears, respectively. The study found that 28.6% of patients who were positive in the first smear did not return for the second smear. The risk factors among smear positive TB patients were co-illness (32.5%), previous history of TB (7.5%) and history of positive TB contact (4.7%). These findings also show that as CD4+ T Cells count increases, the quantity AFB in sputum smear also increase although not statistically significant. The sputum smear positivity rate at Bugando Medical Centre is low and more than a quarter of initial TB suspects who were positive in the first smear were lost to follow up posing a threat of continuous transmission of tuberculosis to the community. The finding of more sputum smear positivity rate among HIV positive than HIV negative patients at BMC requires a prospective study to ascertain whether it is a reality or a coincidence.\u

Results and safety profile of trainee cataract surgeons in a community setting in East Africa

Purpose: To evaluate the results and safety profile of assistant medical officer ophthalmologists (AMO-O) performing cataract surgery in the last stage of their surgical training, before their appointment to local communities. Methods: We retrospectively analyzed the records of patients who underwent cataract surgery by AMO-Os at Dar es Salaam, Comprehensive Community Based Rehabilitation for Tanzania Disability Hospital between September 2008 and June 2011. Surgical options were either extracapsular cataract extraction (ECCE) or manual small incision cataract surgery (MSICS), both with polymethylmethacrylate intraocular lens implantation. Results: Four hundred and fourteen patients were included in the study. Two hundred and twenty-five (54%) underwent ECCE and 189 had MSICS. Mean logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity (UCVA) improved from 2.4 ± 0.6 preoperatively to 1.3 ± 0.8 1 week postoperatively (t-test, P < 0.001) and to 1.1 ± 0.7 3 months postoperatively (t-test, P < 0.001). Mean logMAR best-corrected visual acuity (BCVA) was 0.7 ± 0.5 1 week postoperatively and 0.6 ± 0.5 3 months postoperatively. There was no significant difference in mean logMAR UCVA (P = 0.7) and BCVA (P = 0.7) postoperatively between ECCE and MSICS. 89.5% achieved BCVA better than 6/60 and 57.3% better than 6/18 with a follow-up of 3 months. Posterior capsule rupture and/or vitreous loss occurred in 34/414 patients (8.2%) and was more frequent (P = 0.047) in patients undergoing ECCE (10.2%) compared with MSICS (5.3%). Conclusion: AMO-O cataract surgeons at the end of their training offer significant improvement in the visual acuity of their patients. Continuous monitoring of outcomes will guide further improvements in surgical skills and minimize complications. In the era of phacoemulsification for cataract surgery, extracapsular cataract extraction (ECCE) and manual small incision cataract surgery (MSICS) are still widely held to be the techniques of choice for the developing world.[1],[2],[3],[4],[5] Both MSICS and ECCE are affordable[6] and are considered safe and effective for the treatment of cataract patients in community eye care settings. MSICS appears to provide better postoperative uncorrected visual acuity (UCVA)[1] and faster rehabilitation[7] compared with ECCE although the technique is more challenging. In Tanzania, in addition to medical doctors, there is a special cadre of health professionals, created to care for the large population, called assistant medical officers (AMOs). AMOs can specialize in ophthalmology for 2 years and become AMO ophthalmologists (AMO-O) who perform cataract surgery. AMO-O's are a subtype of nonphysician cataract surgeons previously described by Lewallen et al.[8] AMO-Os deliver high-volume cataract surgery in community eye care settings and are essential in reducing the backlog of cataract-related visual disability. AMO-Os are more likely to set up their practice and stay in rural areas than ophthalmologists tied to larger centers and in addition, their training is shorter and less expensive compared to ophthalmologists.[8],[9] Ensuring sufficient training of AMO-Os in cataract surgery is necessary to achieve good visual outcomes and maintain low rates of complications. This is particularly important in an African community setting, where follow-up may not be optimal and management of complications more challenging. In this study, we evaluate the results and safety profile of AMO-O cataract surgeons. The surgeries were supervised by trainers and performed entirely by the AMO-O in the last stage of their surgical training (6-9 months), before operating independently in their local communities. Patients with diabetes were excluded from the surgical cohort for AMO-Os

Common Preventable Health and Social Problems Encountered by Elderly in Shinyanga Region in the Northern Part of Tanzania

In Tanzania elders are respected as repositories of inherited wisdom, experienced and principal decision makers in the community. However, evidence shows that such repositories are no longer considered important in most societies. As a result elders are neglected with some mistreatment in terms of provision of health and social services for instance; at times they get denied and ignored of their obvious rights, ignoring their retirement benefits and the rights onto free social services as per the Tanzania National Ageing Policy of 2003. Elders are therefore faced with physical, psychological and geriatric social suffering. It is on this basis that this study tries to explore the common preventable health and social problems encountered by elderly in Shinyanga Region in northern part of Tanzania. Across sectional community based study of 465 subjects randomly selected was done in three wards of Kahama District. The district was selected randomly out of 8 districts of Shinyanga Region, structured questionnaires with both closed and opened endower used; the information was collected from house to house and other information collected from health facilities within the wards as every ward had one public health facility; subjects (respondents) were obtained using purposive sampling technique aiming at elderly with 60 years of age and above. Kahama district has a population of approximately 36,014 of which 1500 (4%) are in the elderly age group of 60 years and above. The study population was 465 which is 30% (465/1500) of the geriatric population of Kahama. Among this group 5% were female while 41% were male and 53% (248/465) were married. 64% (297/465) were taking care of themselves, 32% (150/465) cared by relatives and 4% (18/465) cared by the community. Among the respondents, 40% (185/465) were affected by HIV/AIDs in one way or another either living with orphans whose parents died of HIV/AIDS or asking care of the infected patients within the family. It was also found that 73% of the geriatrics were not exempted from medical treatment fees so they had to pay for their medical care. However, only 32% were aware of getting free treatment and 61% of the study populations were not satisfied with the medical care provided at the public health facilities. The common diseases affecting this age group are: Eye problem 59% (273/465); Arthritis 52% (241/465); Dental problems 27% (124/465); Hypertension 23% (107/465); Backache 22% (105/465); Malaria 28% (132/465); Hearing problems 26% (121/645); Urinary tract Infection 35% (165/465); Depression 8% (36/465). Dementia was also a problem though we had no tools to confirm the diagnosis; some of the geriatrics had more than two diseases. The majority of the elderly age group in Kahama District are not aware of their rights that they deserve free treatment according to Tanzania policy, furthermore for assessment and screening of health problems. A majority of the elderly die prematurely due to preventable diseases and more than half of the diseases affecting geriatrics are preventable